TYPES OF HOSPITALS

There are different kinds of hospitals, most of which provide maternity care. Without question, teaching hospitals provide the most modern facilities. Here, doctors are always on duty, so if you run into any complications, there will be someone to attend you. And, as a rule, doctors at teaching hospitals are usually more experienced in dealing with complicated births. The smaller community hospitals are rare now, but they do tend to be more friendly and flexible, although midwives still have to follow the same guidelines as midwives in larger hospitals.

VISITING HOSPITALS

If you can, tour one or more hospitals with your partner before making your final choice. Most maternity hospitals give a formal tour, sometimes as part of general prenatal preparation classes, otherwise as part of the general welcome made to mothers signing up. Find out about when these tours take place and ask if you can join one before you make your decision.

GETTING TO KNOW YOUR HOSPITAL

Hospitals can be intimidating, but usually seem less so when you get to know them. Try to visit the hospital of your choice at least once, more if possible, so that you can meet some of the staff who’ll be caring for you. You’ll also have a chance to get the feel of the routine and look at the delivery room and other facilities. The more time you have to walk around, the more familiar you’ll become with the surroundings so you’re more relaxed when the big day comes. It’s best if you and your partner do this together so that you both get to know the place and the people and will feel confident when you are actually there for the birth itself. Remember, though, that security considerations mean that maternity wards are now carefully monitored, so don’t try to visit without an appointment. Any unannounced visitors are likely to be challenged.

It’s a good idea for you and your partner to take a look around the outside of the hospital and find the emergency entrance. Many women go into labor at night, and having to search for the entrance in the dark is the last thing you need.

CHANGING YOUR HOSPITAL

If you do have problems and you find that your hospital is not meeting your expectations, you don’t have to abandon the system altogether. A hospital is there to serve you; healthcare is a consumer issue and you do have the right to refuse certain procedures. If you’re very unhappy with any aspect of the care at your hospital, you can arrange to be transferred to another one. You could also try getting in touch with the head of the clinic or your obstetrician and explain your feelings and what you think is wrong with the clinic. If you find a sympathetic doctor who you
get along with, you may change ‘your mind about leaving, although it’s unlikely that he or she will be there for your delivery. If you do feel you must change hospitals, your obstetrician will probably recommend another doctor at a center of your choice.

BIRTHING ROOMS

Most hospitals should have birthing rooms available. These are non-clinical and more like your own home, with comfortable chairs, low lighting, soft music, piles of cushions, and drinks and snacks on hand.

The whole aim of a birthing room is to help you relax, overcome fears, and relieve tension. A normal routine before the birth makes for a normal delivery, and once you’re in a birthing room you won’t be moved unless there’s an emergency that needs immediate attention. There shouldn’t be any sudden changes in movement, mood, and surroundings. You won’t have to lie down to have your baby, and you don’t need to be surrounded by intimidating equipment. In a birthing room, you can take up whatever position you want for the birth of your baby.

For many women, a birthing room provides the ideal compromise between home and hospital births. It provides surroundings and facilities as similar as possible to those at home, but with emergency expertise on hand and an epidural available if labor pains become overwhelming.

The Third Stage

During the third stage of labor, the placenta becomes detached from the wall of your uterus and is delivered down the birth canal. The large blood vessels running to and from the placenta, which are about the thickness of a pencil, are simply torn across. Despite this, bleeding is rare because the muscle fibers of the uterus are arranged in a crisscross fashion so that when the uterus contracts down, the muscles tighten around the blood vessels and prevent them from bleeding. This is why it’s absolutely essential that your uterus contracts down into a hard ball once the placenta has been expelled. Massaging every now and then for an hour or so after the third stage is complete can help keep your uterus tightly contracted. Normally the third stage lasts about 10-20 minutes.

Delivering The Placenta

Usually your doctor or midwife won’t try to deliver the placenta until there are clear signs that it’s separating from the wall of your uterus and moving downward into your vagina. The signs your attendants will look for are contractions starting up again a few minutes after the birth of your baby, which shows that the placenta is about to separate, and your desire to bear down-this also shows that the placenta has separated from the wall of your uterus and is pressing down on your pelvic floor.

Once these signs have appeared, your doctor or midwife may encourage the delivery of the placenta by pulling gently on the cord, at the same time pressing above the rim of the pelvis to control descent. You may be asked to push. The placenta is expelled from your vagina, followed by the membranes. Rarely, a blood clot will also be expelled.

How you can help It may take up to half an hour before the placenta arrives. You can help speed things up by breastfeeding your baby because the sucking action stimulates your uterus to contract, thereby helping to expel the placenta. If your baby isn’t ready to suck, stimulating your nipples with your fingers can have the same effect.

Delivery The placenta may pass through your vulva in two different ways. In the first, the center of the placenta comes out first, dragging the membranes behind it. In the second, an edge of the placenta presents first, then it slips out of the vulva sideways. Most women want to see the placenta-it’s an amazing organ that’s been the life-support system for your baby for nine months.

After delivery Once the placenta is delivered, medical staff will check it carefully to make sure it’s complete and none of it has been left behind. If any of the placenta has been left in the uterus it can cause hemorrhaging later on, so it must be removed as soon as possible. If there’s any doubt, you may have an ultrasound scan to see whether the uterus is completely empty. The membranes should form a complete bag except for the hole through which your baby has passed. Your midwife will also check the cut end of the cord to make sure that the umbilical blood vessels are normal. After the placenta is delivered, the whole of your vulval outlet will be examined carefully for tears. Anything other than a minute one will be stitched immediately.

After The Placenta Is Delivered

After the uterus is completely empty and the placenta is delivered, Pitocin is usually given by intravenous infusion. The Pitocin helps the uterus contract and reduce the amount of bleeding. Blood runs through sinuses in the uterus, and when the uterus contracts down to a small ball, these sinuses are closed off. If the uterus does not contract well, you will continue to bleed. At At this point your doctor will start an IV (if you don’t have one already) and give you Methergine to control postpartum hemorrhage and help the uterus tone up. If you have high blood pressure, your doctor can give you a prostaglandin, which will have the same effect as Methergine to stop postpartum bleeding.

Oxytocin The hormone oxytocin is naturally produced by your body when you see and touch your baby and put her to your breast. This natural production of oxytocin helps control excessive bleeding and tone the uterus. At the same time, both you and your newborn benefit from close, skin-to-skin contact.

How You Will Feel

You may find yourself shivering and shaking after the placenta is delivered. After delivery of my second child, I was shivering and my teeth were chattering so much that I couldn’t speak or breathe properly. My own explanation for this is that for nine months I had a little furnace inside me, producing quite a lot of heat, and my body had adjusted to take account of the extra heat by turning my own thermostat down slightly. When my baby left my body, I was deprived of that heat and my body temperature probably dropped a few degrees. The only way the body can raise. Its temperature is to generate heat through muscular work. That’s exactly What shivering does-rapid contraction and relaxation of muscles produces body heat. The shivering usually stops in about half an hour, during which time your body temperature is back up to normal and your own thermostat is reset.

In the early months, use any lovemaking position you like, but as your abdomen gets bigger, you may find some positions uncomfortable. After about 24 weeks, it’s best to avoid lying on your back for any length of time, so don’t use the missionary position, with your partner on top-there are lots of other exciting options. These may also be the best choices when you first start making love again after the birth.

WOMAN-ON-TOP POSITIONS

You may find these the most comfortable from the second trimester onward. As your abdomen grows, you can lift yourself farther off his stomach by supporting yourself on your bent legs. This also prevents too much pressure on your abdomen and breasts. In these positions, too, it’s easier for you to control the depth of penetration and the speed and rhythm of lovemaking.

These positions allow a great deal of intimacy. You and your partner have your hands free to caress and stroke each other and he can easily reach your breasts with his mouth. Alternatively, you can brush his chest with your breasts to stimulate him further.

KNEELING AND SIDE-BY-SIDE POSITIONS

Many of these involve entering from behind, and are useful in pregnancy, particularly if you don’t feel comfortable on your back, or you don’t want to take too active a part in lovemaking.

Kneeling positions allow your partner freedom of movement and let him vary the amount of penetration. Side-by-side positions are comfortable and permit plenty of kissing and caressing. The “spoons” position, so called because the partners nestle together like a pair of spoons, is also good to try if you feel any soreness or discomfort when you start making love again after you’ve given birth, especially if you’ve had an episiotomy.

SITTING POSITIONS

These are good in the middle and late months. They don’t allow a lot of movement but are comfortable for both partners and ease pressure on the abdomen. Also, the depth of penetration can be controlled. Your partner sits on a sturdy, comfortable chair or the edge of the bed and you sit on his lap, either facing him (if your abdomen is not too big), facing to one side, or facing away.

Your partner can use his hands to caress your body and breasts and to stimulate your clitoris. His range of movement is limited, so you control the sexual tempo.

CONTRACTIONS AND PUSHING

The second stage is the expulsion stage-you push your baby out. It lasts from the time your cervix is fully dilated until your baby is born and, for a first baby, generally takes less than two hours. The average second stage lasts about one hour, and it may be as little as 15-20 minutes for subsequent babies. At this time contractions are 60-90 seconds long and come at two- to four­ minute intervals.

You’ll almost certainly feel the urge to push, known as bearing down. The urge is caused by your baby’s head pressing down on your pelvic floor and rectum, and is quite involuntary. Keep your pushing as smooth and continuous as you can; make the muscular effort smooth and slow so that your vaginal and perineal tissues and muscles have enough time to stretch and will be able to accommodate your baby’s head.

The most efficient position to be in when you’re pushing is upright, whether you sit on a birthing stool, stand with your arms around your partner’s neck, or squat. This means that the downward muscular force of your body and the downward force of gravity are working together to push your baby out.

If you’re lying on your back, even if you’re supported by pillows, you’re pushing your baby out uphill against the force of gravity.

This is much harder work, and so delivery is slower.

As you push, it helps if your pelvic floor and anal area are fully relaxed, so make a conscious effort to let go of this part of your body. Don’t be embarrassed if you urinate or lose a little stool­lots of women do and your attendants have seen it all before. When you’ve finished a push, take two slow, deep breaths, but don’t relax too quickly at the end of a contraction. Your baby will continue to maintain her forward progress if you relax slowly. If doctors think that your second stage is going on too long, they might suggest using forceps to assist the delivery of your baby.

WHAT HAPPENS IN LABOR

It’s difficult to be sure about the onset of labor because it differs from woman to woman. Certain classic signs-intense contractions, dilation and thinning of the cervix, and rupturing of the membranes-are taken to mean that labor is underway.

Contractions When true labor starts, the nature of your contractions changes. They become more rhythmic and more painful, and they come at regular intervals. These contractions are not within your control and, once they have begun, won’t stop until your baby is born.

You can time your contractions from the start of one contraction to the start of the next. In early labor, contractions are usually about 30-60 seconds long and come at intervals of about five to 20 minutes. This can vary; some women may not notice their first contractions until they are closer together-say, every five minutes. During the active phase, contractions usually last 60-90 seconds, at intervals of two to four minutes.

As your uterine muscles tighten, you may feel something like menstrual cramps, spreading around your lower abdomen like a tight band. This is because the uterine muscle runs short of oxygen as its blood vessels are compressed. The uterus is a huge muscle and needs a lot of energy during contractions.

Every woman feels contraction pains differently, but in early labor they may be similar to menstrual cramps or a mild backache. Some women experience a persistent and severe backache. Very often a contraction feels like a wave of discomfort all the way across your abdomen that reaches a peak for a few seconds and then diminishes. At the same time, you can feel a hardening and tightening of the uterine muscle, which is held at the peak of its intensity for a few seconds before the muscle begins to relax.

Women assume that contractions will get steadily longer, more frequent, and stronger. This is not so; don’t be disturbed if your contractions seem to vary. It’s as normal for a strong contraction to be followed by a weaker one that doesn’t last quite as long, as it is for contractions to follow one another relentlessly.

Your cervix dilates and thins The cervix is usually a thick-walled canal about three-fourths of an inch (two entimeters) long, and firmly closed. In the last few weeks, pregnancy hormones may soften your cervix, but the intense contractions of first-stage labor are needed to dilate and thin it. Dilation is measured in centimeters from 0-10 (up to four inches). Your cervix will only dilate about four centimeters (or one-and-a-half inches) during the latent phase, then progress to 10 centimeters (four inches) in the active phase. The pain increases as it becomes fully dilated during transition. Eventually, the whole cervix opens up and is made one with the body of the uterus, creating a continuous channel that your baby can pass through.

Your water breaks The membranes of the amniotic sac may rupture painlessly at any time during labor, although this usually happens toward the end of the first stage. Fluid may leak or gush out; the flow depends on the size and site of the break and whether or not the baby’s head is plugging the hole.

Usually, if the membranes rupture spontaneously near term, labor follows within a short time, although occasionally it’s delayed-if your baby’s presenting part is not engaged, or if your baby is presenting abnormally. Delay also occurs in normal cases. When this happens, you’ll be advised to have labor induced.

HOW LONG DOES LABOR LAST?

Labor times vary greatly, but an average labor lasts about 12-14 hours for first-time mothers, and about seven hours for subsequent labors. If your labor lasts longer than 12 hours the first time, or nine hours in subsequent labors, your doctor
will want to find out why progress is slow, and may intervene.

The first stage of labor can be further divided into three separate phases. The latent phase is the longest, lasting about eight hours for first babies, and you’ll feel contractions coming with increasing frequency and length, but they won’t be too distressing. Try to conserve your energy during this time as your body will be warming up for the more demanding phases to follow. The next, active phase, will be shorter, lasting about three to five hours, but this is when your contractions become more painful, and you may want some pain relief. The final, transitional phase, is the shortest and most intense of all, usually lasting just under an hour, and comes right before the delivery.

Transition

This is the most intense phase of the first stage. Your Contractions will now last about 60-90 seconds, with intervals of only 30-90 seconds. As the contractions become more forceful, you may find it hard to relax and this is the time you may feel the most discomfort. You may also feel a very strong urge to push, but should not do so unless you’re fully dilated. The intense pain may make you feel extremely irritable, even bad-tempered with your birth partner. This is natural. Don’t think you’re failing if you fear you lack the energy to go on any more; you’ll find hidden resources of energy to help you cope. Remind yourself that this phase means your baby’s birth is now just minutes away.

UNDERSTANDING YOUR ROLE

It’s normal to feel nervous about being a birth partner, so the best thing to do is prepare yourself. Find out as much as you can so you’re able to help the mother meet the physical and emotional demands of labor. At prenatal classes there’ll be demonstrations to describe labor’s onset and the effect of contractions, and you’ll be taught techniques to help her relax.

Visit the birthing center or the hospital’s labor and delivery rooms and introduce yourself to the staff. Make sure you know the route to the hospital in case of an emergency, and find out all you’ll need to do; trust will create a calmer atmosphere.

HOW TO HELP DURING LABOR

You may have a very active role throughout the labor and birth, but sometimes your presence is all the mother needs. Make sure you’re very familiar with her birth plan and the alternative version and that you know all her wishes.

Use your intuition Judge the situation by observing your partner’s moods. She may want to stay quiet, going through contractions alone without being touched. Or she may needs lots of encouragement or distractions.

Provide emotional support Remain as close and intimate as you can, using loving words, and keep your movements slow, quiet, and steady. Be positive: praise her and don’t criticize. If she wants to hear your voice, constantly tell her how well she’s doing (how far dilated) and how she can relax herself. Tell her what the midwife is doing and what will soon happen. Also, help her to see how much she’s achieved already-it’s easy for her to be overwhelmed by how far she thinks she has to go. Massage and stroke her slowly, but if she just wants to hold your hand, you can encourage her by the expression on your face and lots of eye contact. Sometimes just the look of love in her partner’s eyes can help a woman bear the pain of contractions.

Combat tiredness Before labor, encourage her to rest as much as possible, particularly if she seems to want to rush around cleaning during the nesting period. If her labor is long and tiring, try to help her relax between contractions and save her energy for the second stage. If she’s not feeling nauseous, provide her with any drinks or nourishment she wants.

Help her cope with pain It’s hard to see someone you care about in pain, but try not to show your anxiety-it could make her feel more worried. On the other hand, don’t dismiss her suffering. Acknowledge it positively, telling her each contraction is bringing your baby’s birth closer, and make different suggestions for relief. Help her not to be embarrassed about saying what hurts­encourage her to be as uninhibited as possible. A woman in labor should never be ashamed of needing pain relief.

If she feels particularly anxious during a contraction, it might calm her fears to talk about how she felt before the next one starts. Don’t take it personally if she’s critical or aggressive toward you-this often happens when the pain is very intense.

Help with breathing You’ll probably have practiced your partner’s preferred method in prenatal classes, but let her follow her own rhythm. If she seems to lose control, stay nearby and slowly guide her through the pattern until she’s able to continue on her own. Be ready to adapt-very few people follow exactly what they practiced at prenatal classes.

Make her comfortable You can be a great help here. Suggest different positions and support her with pillows or blankets, or let her lean against you while you cuddle, and rock together. Look for signs of tension in her neck, shoulders, or forehead, and gently stroke these areas. Massage may give some relief from pain. If she’s using visualization techniques, gently talk her through them. She’ll probably find having her face and hands wiped very soothing, or you can offer her ice cubes to suck. If she feels cold, help her put on socks or leg warmers. As labor progresses, she may want to talk less, but you can keep in touch by touching or caressing, or by using eye contact.

The need for a cesarean section may be apparent well before labor begins, so you, your partner, and your obstetrician have time to talk through what will happen-this is an elective cesarean. In emergencies, the need only becomes evident once labor is under way.

Elective Cesarean Section

The most common reasons for choosing to have a cesarean include failure to progress in labor or dystocia (abnormally slow progress of labor), your baby being in a breech position or lying across your pelvis; placenta previa; and certain medical conditions such as active herpes type II infection. A cesarean may also be necessary if you’ve had one for a previous baby-the worry used to be that the scar would open up again. Experience has shown that this does not happen with the horizontal or “bikini” cut, now generally used instead of the vertical cut, and so hospitals often allow a vaginal delivery to begin, and if there are no problems, labor goes on as normal- a “trial of labor.”

Elective cesareans are often carried out under a spinal anesthetic. This has several advantages over a general anesthetic: it’s safer for your baby; you have no postoperative nausea or vomiting; and because you are conscious, you can hold your baby as soon as he’s born. It’s usually possible for your partner to be with you during the operation, just as he can be at a vaginal delivery.

When you’ve had a cesarean, you may feel deeply disappointed that you didn’t have a vaginal delivery. It’s natural to feel this way, and the best thing you can do is talk to your partner about it. If he describes the birth to you in detail it may help you to visualize and accept it. Also, remember that the way your child comes into the world isn’t nearly as important as having a healthy baby.

It also helps, of course, to prepare yourself in advance for this type of birth. Go and see the obstetrician with your partner and find out what the operation involves, what procedures will be used, and whether your partner is allowed to be there. Ask if you can see a video so you’ll know what’s going to happen to you. If you can, talk to other women who’ve had cesarean sections. They’ll be able to give you useful advice and reassurance.

Emergency Cesarean Section

An emergency C-section may be needed when something goes wrong during labor, such as a prolapsed umbilical cord, placental hemorrhage, fetal distress, or serious failure to progress in labor. Emergency cesarean sections may be carried out under epidural and the hospital may not allow your partner to be present at the operation.

After a Cesarean Section

As is the case with any major surgery, it takes time to recover from a cesarean, but even so you’ll be encouraged to get up and walk around a few hours afterward to stimulate your circulation. You’ll be given painkillers if you need them, and the dressings will be removed after three or four days. Your internal stitches will be made with absorbable sutures, which will dissolve away naturally. Skin stitches may also be absorbable, but if staples are used they should be removed within about a week.

WHAT TO EXPECT

The hospital surroundings will be unfamiliar, and this can make you feel anxious, but here are some tips to help you make yourself more comfortable. You’ll probably have been told to leave all valuables at home, but when you get to the hospital, you may be asked to remove any remaining personal items such as jewelry. If this worries you, ask if you can keep your personal belongings with you in a bag. If you wear contact lenses, ask about the hospital’s policy beforehand-they may prefer you to bring your glasses instead.

After admission, When you arrive at the hospital, you’ll need to go through brief hospital admission procedures. Your midwife or doctor will ask you about how your labor is going-how often you’re having contractions and whether your water has broken, for example. Then she will examine your abdomen to confirm the situation, feel your baby’s position, and check your baby’s heart. Your blood pressure and temperature will be taken, and you’ll be given an internal examination to see how far your cervix has dilated. They will probably ask you to wear a fetal monitor for about 20 minutes, but afterward you should be able to move around as much as you wish.

Giving birth

If you’ve decided that you prefer to manage without drugs for as long as you can during labor, the midwives will usually be more than happy to help you cope using other methods of pain relief. Bear in mind, though, that drug relief is available if you want it, and you can ask to start with smaller doses if you don’t feel you need the full measure.

Once your baby is descending, you may be helped into a semi­reclining position. If you’re in any danger of tearing, you may need to have an episiotomy when your baby’s head is crowning. If forceps have to be used, an episiotomy is more likely. Your baby will be delivered onto your abdomen, and while you take your first look at each other, you’ll be given an injection of Syntometrine into your thigh. This is to make sure that your uterus will contract firmly, reducing the chance of severe bleeding after the delivery of the placenta. Your baby will then be given the Apgar tests while you are cleaned up. If you need to have stitches, these are usually done at this point, either by the midwife or the doctor.

THE ADVANTAGES

For some mothers, a hospital birth gives the best chance of a successful and happy outcome. Having your baby in the hospital is the safest option if you suffer from a medical condition such as heart disease or diabetes, if you’re expecting twins, if your baby is known to be breech, or if, as a first-time mother, your obstetrical history just presents too many unknown factors.

Should anything go wrong during the labor and birth, emergency medical assistance is on hand right away, and there’s a wide range of pain-relief medication readily available should you want it. You may feel happier knowing that your baby can be given treatment in an intensive care unit if the need arises.

By staying in the hospital after the birth, you may get more rest than you would at home, especially if you have other children.

THE DISADVANTAGES

Once you’re in the hospital, it’s easy to feel overpowered by the atmosphere, although some are getting more relaxed about childbirth. Bear in mind that hospital staff have to follow rules and routines, and you’re going to have to fit in with them. But that doesn’t mean that you should have to do anything you aren’t happy about. Your partner may feel a bit awkward and separate from the birth of his child, so try to include him in whatever way you can. It helps to find out as much as you can about the hospital procedures and setup beforehand so that you’re more prepared once you go into labor.

Your Baby’ s Progress

During this month your baby will usually shed most of the lanugo (fine hair) from his body. There may be some small patches left in odd places and perhaps some in his body creases. His skin is smooth and soft, and there is still some vernix caseosa left on it (mostly on his back), which will help his passage down canal. He’ll be almost chubby before birth. His fingernails are long and may have scratched his face-they’ll need after birth. His eyes are blue, although they may change in the weeks after birth. When he’s awake, his eyes are open. In these last weeks, your baby produces increasing amounts of a hormone called cortisone from his adrenal glands. This helps his lungs to mature and prepare for his first breath.

Meconium Your baby’s intestines are filled with a dark green, almost black, substance called meconium. This is a mixture of the secretions from his alimentary glands together with the lanugo that’s been shed from his body, pigment, and cells from the wall of his bowel. It’ll be the first bowel motion he’ll pass after birth, but he may pass it during delivery.

Immune system His own system is still immature, so to make up for this he receives antibodies from you via the placenta. These protect him against anything that you have antibodies for, such as flu, mumps, and German measles. After he’s born, he’ll keep getting antibodies from you via your breast milk.

His Support System

The placenta now measures 8-10 inches (20-25 cm) in diameter and is just over an inch (3 cm) thick, thus creating a wide area for the exchange of nourishment and waste products between your system and your baby’s. There’s now more than a quart (liter) of water in the amniotic sac.

The hormones made by the placenta are stimulating your breasts to swell and fill with milk. This also causes swelling in your baby’s breasts, whether it is a boy or a girl. This will go down after birth. If your baby is a girl, the stopping of these same hormones following delivery may cause her to have a light bleeding from her vagina (like a period) a few days after her birth.

Your Baby’s Progress

Her organs are now almost fully mature, except for her lungs. These aren’t yet completely developed, although they’re making increasing quantities of surfactant, the fluid that will stop them from collapsing once she begins to breathe air. She makes strong movements that can be felt on the surface of your abdomen. Almost all babies born at this time survive.

Her skin, nails, and hair Her skin is now pink rather than red, because of the deposits of white fat underneath it. Fat deposits , build up under her skin to provide energy and regulate her body temperature after she’s born. The protective vernix caseosa that covers her skin is now very thick. Her fingernails now reach the ends of her fingers but her toenails are not yet fully grown. She may have quite a lot of hair on her head.

Her eyes Her irises can now dilate and contract. They’ll contract response to bright light, and also to allow her to focus, although she won’t need to develop this skill until after she’s born. She can close her eyelids, and she has begun to blink.

Her position Some babies take up the head-downward position about now, but there’s still plenty of time-most don’t engage until after 36 weeks. She may remain in the breech (bottom­down) position until birth, although most babies do turn on their own.

Her Support System

From this month the placenta layers may start to thin. To make estrogen, the placenta converts a testosterone-like hormone that’s made by your baby’s adrenal glands. By this month these glands are as big as those of an adolescent, and every day they produce 10 times as much hormone as an adult’s adrenal glands. They’ll shrink rapidly after birth.

The amniotic sac, or bag of waters, contains a large amount of fluid, most of which is the baby’s urine-she can produce as much as a pint (half a liter) of urine every day. Excess vernix caseosa, nutrients, and products necessary for the maturing of the her lungs are also in the amniotic sac. The umbilical cord is large, strong, and tough. A firm, gelatinous substance surrounds the blood vessels and prevents kinks or knots in the cord that could affect your baby’s blood supply.